Surgical management and follow-up of triceps tendon avulsion after repeated local infiltration of steroids: two cases

P. García-Fernández; P. Quero Martín; A. Mayenco; M. Gardoqui; I. Calvo

doi:10.3415/VCOT-14-01-0004

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2014; 27(05): 405-410
DOI: 10.3415/VCOT-14-01-0004

Case Report

Schattauer GmbH

Surgical management and follow-up of triceps tendon avulsion after repeated local infiltration of steroids: two cases

P. García-Fernández

¹Department of Animal Medicine and Surgery, Veterinary School, Complutense University of Madrid, Madrid, Spain

,

P. Quero Martín

¹Department of Animal Medicine and Surgery, Veterinary School, Complutense University of Madrid, Madrid, Spain

,

A. Mayenco

¹Department of Animal Medicine and Surgery, Veterinary School, Complutense University of Madrid, Madrid, Spain

,

M. Gardoqui

¹Department of Animal Medicine and Surgery, Veterinary School, Complutense University of Madrid, Madrid, Spain

,

I. Calvo

²Division of Small Animal Clinical Sciences, School of Veterinary Medicine, University of Glasgow, Glasgow, UK

› Author Affiliations

Abstract

Summary

Disruption of the triceps tendon insertion is an uncommon injury, with only a few reports of traumatic triceps tendon avulsion in dogs or cats present in the veterinary literature. Although this injury has been previously described in two dogs that had received a local injection of corticosteroids for the treatment of soft tissue injuries, reports with long term clinical follow-up and outcome in working dogs are lacking.

This report describes two surgically treated cases of complete triceps tendon avulsion rupture in Malinois police dogs. These two dogs had a history of repeated local infiltration of a corticosteroid preparation used to treat adventitial bursitis. The clinical features, surgical treatment, long-term management and outcome are reported. A modified triple locking loop pattern was used to suture the tendons. The long-term outcome was considered excellent with both dogs resuming work. Although it is an uncommon condition in small animals, avulsion of the triceps tendon should remain on the differential diagnosis list for acute onset forelimb lameness, particularly if there is a history of local infiltration with corticosteroids. The diagnosis should be based on clinical, radiographic and ultrasonographic examination.

Keywords

Triceps tendon rupture - steroids - adventitial bursitis

Full Text

References

References
1 Davies JV, Clayton-Jones DG. Triceps tendon ruptures in the dog following corticosteroids injection. J Small Animal Pract 1982; 23: 779-787.
2 Clarke SP, Jermyn K, Carmichael S. Avulsion of the triceps tendon insertion in a cat. Vet Comp Orthop Traumatol 2007; 20: 245-247.
3 Liehmann L, Lorinson D. Traumatic triceps tendon avulsion in a cat. J Small Animal Pract 2006; 47: 94-97.
4 Gilmore DR. Triceps avulsion in the dog and cat. J Am Anim Hosp Assoc 1984; 20: 239-242.
5 Anson LW, Betts C. Triceps tendon avulsion in a dog: Surgical management and xeroradiographic evaluation. J Anim Hosp Assoc 1989; 25: 655-658.
6 Brunnberg L, Hendrikx J, Waibl H. Abribder Anastzsehne des musculus triceps brachii bei einer Sheltie-Hundin [Abrasian of the tendon of insertion os musculus triceps brachii for Sheltie bitch]. Kleintierpraxis 1997; 42: 827-834.
7 Hossain MA, Pork J, Choi SH. et al Dexamethasone induces apoptosis in proliferative canine tendon cells and chondrocytes. Vet Comp Orthop Traumatol 2008; 4: 337-342.
8 Tarsney FF. Rupture and avulsion of the triceps. Clin Orthop Rel Res 1972; 83: 177-183.
9 Isbell WM. Chapter 36 - Tendon Ruptures. In Brukner P, Khan K. editors Brukner & Khan's Clinical Sports Medicine. Philadelphia: Mosby; 2006: 367-370.
10 Moores AP, Comerford EJ, Tarlton JF. et al Biomechanical and clinical evaluation of a modified 3-loop pulley suture pattern for reattachment of canine tendons to bone. Vet Surg 2004; 33: 391-397.
11 Monk ML, Preston CA, McGowan CM. Effects of early intensive postoperative physiotherapy on limb function after tibial plateau levelling osteotomy in dogs with deficiency of the cranial cruciate ligament. Am J Vet Res 2006; 67: 529-536.
12 Piermattei DL, Johnson KA. Approach to the humeroulnar part of the elbow joint by tenotomy of the Triceps tendon. In: An Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat. Philadelphia: Saunders; 2004: 200-207.
13 Sierra RJ, Weiss NG, Shrader MW. et al Acute triceps ruptures: Case report and retrospective chart review. J Shoulder Elbow Surg 2006; 15: 130-134.
14 Farrar 3rd EL, Lippert 3rd FG. Avulsion of the triceps tendon. Clin Orthop Relat Res 1981; 161: 242-246.
15 Miles JW, Grana WA, Egle D. et al The effect of anabolic steroids on the biomechanical and histological properties of rat tendon. J Bone Joint Surg Am 1992; 74: 411-422.
16 Van Riet RP, Morrey BF, Ho E. et al Surgical treatment of distal triceps ruptures. J Bone Joint Surg Am 2003; 85 A 1961-1967.
17 Kennedy JC, Willis RB. The effects of local steroid injections on tendons: a biomechanical and microscopic correlative study. Am J Sports Med 1976; 4: 11-21.
18 Balasubramaniam P, Prathap K. The effect of injection of hydrocortisone into rabbit calcaneal tendons. J Bone Joint Surg 1972; 54 B 729-734.
19 Cook JL, Linville C, Stoker A. et al Effects of local anesthetics and steroids on articular tissues. Proceedings of the Veterinary Orthopaedic Society 40th Annual Conference Abstracts. 2013 March 9-16; Canyons Resort, Utah, USA. Vet Comp Orthop Traumatol 2013; 26: A13-23.
20 Tagliafico A, Gandolfo N, Michaud J. et al Ultrasound demonstration of distal triceps tendon tears. Eur J Radiol 2012; 81: 1207-1210.
21 Spinella G, Loprete G, Musella V. et al Cross-sectional área and mean echogenicity of shoulder and elbow tendons in adult German Shepherd dogs. Vet Comp Orthop Traumatol 2013; 26: 366-371.
22 Sisson C, Nagdev A, Tirado A. et al Ultrasound diagnosis of traumatic partial triceps tendon tear in the emergency department. J Emerg Med 2011; 40: 436-438.
23 Khiami F, Tavassoli S, De Ridder Baeur L. et al Distal partial ruptures of triceps brachii tendon in an athlete. Orthop Traumatol Surg Res 2012; 98: 242-246.
24 Aron DN. A ‘new’ tendon stitch. J Am Anim Hosp Assoc 1981; 17: 587-591.
25 Gelberman RH, Boyer I M, Brodt MD. et al The effect of gap formation at the repair site on the strength and excursion intrasynovial flexor tendons. J Bone Joint Surg Am 1999; 81: 975-982.
26 Dueland R, Quenin J. Triceps tenotomy: biomechanical assessment of healing strength. J Am Anim Hosp Assoc 1980; 16: 507-512.